M|C 31S ub||c hea|th |ntervent|ons |n pract|ce what works

nCW SnCULD WL DLCIDL WnI Cn n IN1LkVLN1I CNS 1C DLLI VLk?

Lvldence of need e epldemlololcal needs assessmenL
2 Lvldence of effect|veness deduced from hlhesL level research (e SysLemaLlc
revlew meLaanalysls 8C1)
3 Lvldence of safety ls lL free from unwanLed sldeeffecLs?
4 Lvldence of eff|c|ency (cosLeffecLlveness) an accepLable cosL for an areed
ouLcome (Lhe nlCL case cosL/CAL?)
3 Lvldence of equ|ty does Lhe lnLervenLlon affecL everyone equally accordln Lo
need?
6 Lvldence of feas|b|||ty can lL be lmplemenLed wldely?
7 Lvldence of acceptab|||ty Lo lndlvlduals and Lo socleLy
1nLCkILS CI 8LnAVICUk CnANGL

Ind|v|dua| opu|at|on
Lxp|a|n|ng behav|ours ealLh bellef model

2 Soclal learnln Lheory
lnnovaLlon dlffuslon
Lheory
2 ranlsLalonal Lheory
|ann|ng Intervent|ons

1heory of reasoned acLlon

2 1heory of planned
behavlour

Soclal markeLln Lheory
2 CommunlcaLlon Lheory


Wn IS LVALUA1ICN AND LVIDLNCL IMCk1AN1?

LvALuA1ln
necesslLy
eLhlcal
poLenLlal
harm
opporLunlLy
cosLs
economlc
scarslLy of
resource
1he process by whlch we [ude Lhe worLh or va|ue of an |ntervent|on
Cutcome CuanLlflcaLlon of Lhe effecLs beneflclal or oLherwlse of an lnLervenLlon
rocess CuallLaLlve or quanLlLaLlve assessmenLs of how and why effecLs (or lack of
Lhem) were observed and Lhe meanln and experlence of Lhe lnLervenLlon for Lhose
lnvolved
ulllL8Ln1 ML1uS AvL ulllL8Ln1 8LLS
Lxample
Cutcome A randomlsed conLrolled Lrlal Lells us LhaL a healLh educaLlon leafleL senL
Lo cusLomers wlLh Lhelr hollday LlckeLs does noL chane sunLannln behavlour
amonsL packaehollday makers
rocess A quallLaLlve sLudy wlLh ln depLh lnLervlews of 8C1 parLlclpanLs Lells us
LhaL
MosL hollday makers dld noL read Lhe leafleL as Lhey LhouhL lL was [unk mall" and
dlscarded lL lmmedlaLely
1hose who had read lL could noL recall Lhe maln messae
1nL LVIDLNCL nILkAkCn
Metaana|ys|s and/or systemat|c rev|ews of a body of evldence from welldeslned
randomlsed conLrolled Lrlals
2 Jelldeslned kC1s wlLh lndlvldual allocaLlon
3 Jelldeslned random|sed contro||ed Lrlals wlLh clusLer (roup) allocaLlon
4 Jelldeslned contro||ed tr|a|s wlLh no random|sat|on
3 unconLrolled Lrlals (beforeandafLer or cohort stud|es)
6 Casecontro| stud|es
7 CuaslexperlmenLal sLudles natura| exper|ments
8 Case reports case serles
;UALI1 CI kLSLAkCn LVIDLNCL
Interna| va||d|ty ablllLy of a research sLudy Lo yleld unb|ased resu|ts (are we measurln
whaL we Lhlnk we are measurln?")
f facLors LhaL affecL our ablllLy Lo aln a Lrue and accuraLe resulL many Lypes
(e observer error measuremenL error confoundln publlcaLlon blas)
Lxterna| va||d|ty enerallsablllLy (app||cab|||ty to oLher real llfe slLuaLlons)
8ellablllLy repeaLablllLy by dlfferenL lnvesLlaLors ln dlfferenL clrcumsLances
CASL S1UD 1 kLVLN1ING DLN1AL DLCA
I|uor|de Lechnololcal advances and pollcy measures
NnS po||c|es access Lo free denLal care (resource lncenLlve) for chlldren prenanL women
and welfare clalmanLs
Lducat|on campalns LareLln chlldren wlLh advlce Lo brush LeeLh avold sweeLs eLc
8LvLn1l nC 11 uLCA?

o||cy Local pollcles on fluorldaLlon
2 naLlonal fluorldaLlon lelslaLlon
3 ollcy on access Lo nS denLal care
Lducat|on lnformaLlon and edu abouL denLal hylene ln schools
anLenaLal cllnlcs vla denLlsLs
2 Medla campalns
1echno|ogy lluorlde LooLhpasLe
2 lluorldaLlon of waLer supplles
3 uenLal floss
kesources lree denLal checkups for speclflc roups (prenanL woman
chlldren on beneflLs)
CASL S1UD 2 INIUk kLVLN1ICN
roduct modlflcaLlon Lechnololcal advances and pollcy measures
Leg|s|at|on speed llmlLs flnes eLc
NnS po||c|es home safeLy loan equlpmenL schemes (resource lncenLlves) eLc
Lducat|on cycle proflclency Lralnln reen cross code eLc
8LvLn1l nC ACCluLn1AL ln!u8?

o||cy 8oad safeLy lelslaLlon
2 nhs pollcles on home safeLy edu loan schemes
Lducat|on Medla campalns on speed llmlLs unwanLed drus home safeLy
2 ulrecL advlce from healLh vlslLors
3 Sure sLarL prorams
1echno|og|y SeaL belLs sldelmpacL bars A8S brakes eLc
2 Chlld reslsLanL conLalners
3 Crash helmeL
4 ome safeLy equlpmenL
kesources
Subsldlsed home safeLy equlpmenL loan schemes


WnA1 SnCULD WL DC A8CU1 kC8LLM DkINkING?
W J Lurope Lop 3 besL pracLlces Lo reduce alcoholrelaLed harm ln populaLlons
(mosL cosLeffecLlve per uAL? saved)
lncrease LaxaLlon
Screenln and brlef lnLervenLlons (S8l)
AdverLlsln ban
8educe openln hours (e weekend closln day)
8andom breaLh LesLs for drlvers
JA1 lS SC8LLnlnC Anu 88lLl ln1L8vLn1ln?
W Secondary prevenLlon
ldenLlfles lnclplenL problems ofLen asympLomaLlc buL poLenLlally responslve
Lo chane
W Screenln Case flndln
Can be unlversal or LareLed
locus on nonLreaLmenL seekers
W 8rlef lnLervenLlon 320mln lnpuL
Slmple sLrucLured advlce usln moLlvaLlonal counsellln
rovlslon of clear wrlLLen lnformaLlon
LvluLnCL l8 88lLl ln1L8vLn1lnS S18nCLS1 ln 8lMA8? CA8L
LffecLlve ealLh Care 8ulleLln 3 ([usL 0 care) meLaanalysls of 6 Lrlals of 8l 24
drop ln consumpLlon (Cl 8 Lo 3)
2 SysLemaLlc revlew by Moyer eL al 2002 (0 20 care) ldenLlfled 34 C Lrlals 36
alLoeLher (8l v conLrols) SlnlflcanL effecL slzes for 8l (nonLreaLmenL seekers)
3 SysLemaLlc revlew by kaner eL al 2007 ([usL 0 care) 2 Lrlals (C AL) Averae
drop of 43 drlnks per week
No s|gn|f|cant benef|t of |ntens|ve counse|||ng over 8I

nCW MUCn DC CU DkINk?
CounL up Lhe number of unlLs of alcohol you have drunk ln Lhe lasL 7 days
unlL Z plnL beer laer clder
small (23ml) lass wlne
shoL (23ml) of splrlLs
(approxlmaLely)
J 1 ASSLSS ?u8 CnSuM1ln M8L ACCu8A1LL?
W unlL of Alcohol
0 ml of 00 alcohol by volume (A8v)
W unlLs A8v x volume (ml) / 000
W lf you drlnk 300ml of beer whlch ls 3 A8v ow much alcohol does Lhls
conLalnne? (23 plnL)
J MuC SuLu ?u u8lnk?
Men

Jomen

WnA1 I S 1nL kCLL CI 1nL DCC1Ck I N U8LIC nLAL1n?
W LxperL advlce
W lannln and sLraLey
W 8esearch epldemloloy evaluaLlon healLh servlces research
W Advocacy
W 1reaLln paLlenLs LherapeuLlc prevenLlve behavloural eLc
W opulaLlon lnLervenLlons
W 8eferral Lo oLher professlonals lncludln nonmedlcal pracLlLloners